| NPI | 1346356359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-190) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: WA PA60595202) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2020-04-29 |